MEDICARE: ANN ARBOR FOOT CLINIC P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	5901002011	MI
2	213E00000X	Podiatrist	5901002011	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480H16064	OTHER		BLUE CROSS/BLUE SHIELD
2	4858150120	OTHER		BLUE TRADITIONAL & TRUST

General Provider Information

NPI Number	:	1083892178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN ARBOR FOOT CLINIC P.C.

Provider Business Mailing Address
First Line	:	2550 DEXTER RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-2702
Country	:	US
Telephone Number	:	734-994-9111
Fax Number	:	734-994-4410

Provider Business Practice Location Address
First Line	:	2550 DEXTER RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48103-2702
Country	:	US
Telephone Number	:	734-994-9111
Fax Number	:	734-994-4410

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LORI ANN SHELDON
Credential	:	D.P.M.
Telephone Number	:	734-994-9111

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	03/27/2008

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